Over 100 countries and territories now require cigarette picture health warnings, marking a significant milestone in global public health that will reduce smoking and save lives.

The Canadian Cancer Society (CCS) has released a report ranking 205 countries and territories on the size of their health warnings on cigarette packages, and listing countries and territories that require graphic picture warnings.

The report shows significant global momentum toward plain packaging, with four countries requiring plain packs and 14 working on the measure.

“There is a powerful, worldwide trend for countries to use graphic pictures on cigarette packages to show the devastating health effects of smoking, and to require plain packaging,” says CCS’s senior policy analyst Rob Cunningham.

Examples of graphic picture warnings include a diseased lung or mouth, a patient with lung cancer in a hospital bed and a child being exposed to secondhand smoke. The report also reveals that many countries have increased the size of picture warnings on cigarette packages – and these larger pictures are known to be more effective.

Cigarette package warnings are a highly cost-effective way to increase awareness of the negative health effects of smoking and to reduce tobacco use. Picture-based warnings convey a more powerful message than a text-only warning, and larger ones increase impact.

Other report highlights include:

105 countries and territories have finalized picture warning requirements, an increase from the 77 that had implemented these requirements by the end of 2014. In 2001, Canada was the first country to require picture warnings and to require a 50 percent size.

58 percent of the world’s population is covered by the 105 countries and territories that have finalized picture warning requirements.

Nepal has the largest warnings in the world with picture warnings covering 90 percent of the package front and back. Vanuatu will also require 90 percent picture warnings in 2017. India and Thailand have the next largest warnings at 85 percent of the front and back.

94 countries and territories require warnings to cover at least 50 percent of the package front and back (on average), up from 60 countries in 2014 and 24 in 2008.

Implementation by most European Union (EU) countries of the new EU requirement for 65 percent picture warnings was an important development contributing to the increase since 2014 in the number of countries requiring picture warnings.